Jessica Rae Clark, LMFT
Individual provider Active NPI Marriage & Family Therapist · Malibu, CA
NPI 1467585018 · NPPES record last updated Sep 28, 2018
Key facts
- NPI
- 1467585018
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Marriage & Family Therapist 106H00000X
- License
- 51030 (CA)
- Practice address
- 22669 Pacific Coast Hwy
Malibu, CA 90265-5036 - Phone
- (310) 339-4486
- NPI assigned
- Mar 13, 2007
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 51030 | CA | MD | Marriage & Family Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Octave Behavioral Health PC | Past | Accepting new patients | |
| Soba Outpatient and Recovery LLC | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Marriage & Family Therapist | 106H00000X | 51030 | CA | Yes |
Addresses
Primary practice location
22669 Pacific Coast Hwy
Malibu, CA 90265-5036
Mailing address
23440 Civic Center Way Ste 102
Malibu, CA 90265-5901
Phone (310) 339-4486
Other providers in Malibu, CA
- Barbara Jean Carey
- Kim Carnazzola
- Carrara Beach House
- Deepa Chemery
- Taber Lung Chinn
- Cliffside Malibu
- Cliffside Malibu 1
- Cliffside Malibu 3
- Cliffside Malibu II
- Cliffside Malibu Outpatient Services
All providers in Malibu, CA · Marriage & Family Therapist in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 28, 2018. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.